An Audit of Perioperative VTE Risk Assessment and Prophylactic Anticoagulation

Abstract

Abstract Background: Venous thromboembolism (VTE) can arise following significant general surgery. Among hospitalized patients in the U.S, pulmonary embolism has been listed as the most common cause of death. Surgery itself is a risk factor for VTE, In the majority of required quality initiatives, preventing VTE is thought of as a patient safety strategy. Many approaches have been used in the fight against venous thromboembolism. These devices pharmaceutical products such as fondaparinux, low-molecular-weight heparin, and unfractionated heparin, as well as mechanical devices such as graded compression stockings (GCS) and intermittent pneumatic compression (IPC) devices. Most of the methods incorporate both of these methods. Patients undergoing surgery should receive VTE prophylaxis and the level of VTE prophylaxis for surgical patients needs to be in line with the anticipated risk. The total risk category is determined by the type of surgery and VTE risk factors. There are a number of published guidelines for determining VTE risk with widely divergent approaches. Numerous risk assessment scores exist, such as the Caprini RAM, Khorana score, and Padua score. Of these, the Caprini RAM was chosen for use in this audit because of its greater validity than the other assessment scores. In addition, the caprini score was found to be far more effective than the Khorana prediction score for identifying hospitalized individuals at risk of VTE. Moreover, 40% of patients with a high Caprini score had a non high Padua score, indicating that the Caprini score rather than the Padua score may be more appropriate for assessing VTE in surgical patients. Methods: An interview was performed with the surgical staff, consisting of interns and residents, who were responsible for preparing patients for surgery to obtain prospective data. The telephone or in-person interview took place in June or August 2021 and consisted of three questions with one response per question. Results: Following the application of the Caprini RAM, 71 (36.6%) of the 194 patients were at risk for deep vein thrombosis (DVT). A total of 123 (63.4%) of the patients did not recieve a score evaluation since the doctors in charge of getting the patients ready for the theatre were not aware of the VTE risk assessment. Ten patients (5%) in one unit were given prophylactic heparin before laparoscopic cholecystectomy, based more on personal experience than on a risk evaluation. Conclusion: It became clear that staff knowledge was below what was originally expected and more than 90% were not able to apply any VTE risk assessment scoring system. However, a surprisingly low number of staff said they were aware of the risk assessment scoring system for VTE but they were not applying this system either because they were not aware of the seriousness of the DVT or because they lacked the knowledge that peri-operative measures such as drugs for examples, can be given safely to patients at risks without major bleeding as a complication.